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Caregivers in older peoples’ care: perception of quality of care, working conditions, competence and personal health
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 704-714Article in journal (Refereed) Published
Abstract [en]

The aim was to describe and compare nursing assistants’, enrolled nurses’ and registered nurses’ perceptions of quality of care, working conditions, competence and personal health in older peoples’ care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient’s Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers’ different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours. © 2012 Nordic College of Caring Science.

Place, publisher, year, edition, pages
2013. Vol. 27, no 3, p. 704-714
Keywords [en]
caregivers; competence; health; older people's care; organisational climate; quality of care; stress of conscience; working conditions
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
URN: urn:nbn:se:du-12472DOI: 10.1111/j.1471-6712.2012.01083.xISI: 000321625800025OAI: oai:DiVA.org:du-12472DiVA, id: diva2:622846
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Health and quality of care from older peoples' and formal caregivers' perspective
Open this publication in new window or tab >>Health and quality of care from older peoples' and formal caregivers' perspective
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective.

Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II).

The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV).

Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II).

Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV).

Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2011. p. 78
Series
Karlstad University Studies, ISSN 1403-8099 ; 2011:63
Keywords
Older people, community care, dependency, health, adaptation, compensation, phenomenology, quality of care, organizational climate, stress of conscience, competence, health, sense of coherence, formal caregivers
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-15765 (URN)978-91-7063-402-4 (ISBN)
Public defence
2012-01-20, 1B306 Fryxellsalen, Karlstads universitet, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2014-09-16Bibliographically approved

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